Why falls happen, and how strength and balance exercise helps

Who is at risk of falling, why falls happen, and the strong evidence that strength and balance exercise, like the Otago programme and tai chi, prevents falls in older adults.

7 min read · last reviewed October 1, 2026

Maybe you tripped on the edge of a rug last month. Maybe you've started holding on to furniture as you walk around the house. Or maybe you're worried about a parent who seems less steady than before. Falls are something many families think about, but don't always talk about.

Here is the encouraging part: falls are common, but they are not a normal part of getting older, and many can be prevented. One of the best tools is something you can start at home: strength and balance exercise.

How common are falls?

• About 1 in 4 adults aged 65 and over falls each year, according to the U.S. Centers for Disease Control and Prevention. In Canada, 20 to 30 percent of older adults fall each year.
• Falls are the leading cause of injury in older adults, and the cause of most hip fractures.
• Fewer than half of people who fall tell their doctor.

A fall can do more than cause a bruise or a broken bone. Many people lose confidence afterwards and start doing less. That leads to weaker muscles and worse balance, which makes another fall more likely. Breaking this cycle is the goal.

Why do falls happen?

Most falls don't have just one cause. They usually happen when several things add up. Here are the most common ones:

Things in your body

• Weaker leg muscles, especially around the hips, thighs and ankles
• Balance problems, from inactivity, inner ear problems or nerve damage in the feet
• Feeling dizzy or light-headed when you stand up (a drop in blood pressure)
• Eyesight problems, such as cataracts or out-of-date glasses
• Foot problems, such as pain, numbness or poorly fitting shoes
• Health conditions such as arthritis, Parkinson's disease, stroke, dementia, diabetes or bladder problems that make you rush to the toilet
• A previous fall, which is one of the strongest signs of future falls
• Fear of falling, which can lead to moving less

Medicines

Some medicines can make you sleepy, dizzy or unsteady. These include some sleeping pills, medicines for anxiety, depression or mood, some pain medicines, and some blood pressure medicines. Taking several medicines together raises the risk. See our guide Falls-proofing your home and health.

Things around you

• Clutter, loose rugs and cords
• Poor lighting, especially at night
• Stairs without rails, slippery bathroom floors
• Ice, uneven pavements and rushing

Something you can do today: Think about any falls or near-misses you've had in the past year. Write them down to tell your doctor.

Who is most at risk?

Your risk is higher if you:

• Have fallen in the past year
• Feel unsteady when standing or walking
• Worry about falling
• Need to use your arms to get up from a chair
• Take four or more medicines, or medicines that cause drowsiness or dizziness
• Have trouble seeing, or problems with your feet

You can check your own risk using the free "Stay Independent" checklist from the CDC's STEADI programme, then share it with your doctor.

The strongest evidence: strength and balance exercise

This is the most important message on this page. Exercise prevents falls, and the evidence is strong.

A large Cochrane review in 2019 pooled results from 108 trials involving more than 23,000 older adults living at home. It found that:

• Exercise reduced the number of falls by about 23 percent, about a quarter.
• Programmes focused on balance and functional exercises (like practising standing up, stepping and turning) reduced falls by about 24 percent.
• Programmes combining more than one type, usually balance plus strength exercises, reduced falls by about 34 percent, about a third.
• Tai chi probably reduced falls by about 19 percent.

International falls guidelines recommend balance and strength exercise at least 3 times a week, getting gradually harder, and continued for at least 12 weeks, and ideally for life. The benefits fade if you stop.

The Otago Exercise Programme

The Otago Exercise Programme was developed by researchers at the University of Otago in New Zealand. It includes:

• Leg strengthening exercises, such as knee straightening, side leg raises, and rising onto your toes and heels, often with ankle weights
• Balance exercises, such as standing on one leg, walking heel to toe, and sit-to-stand, starting with support and gradually letting go
• Walking, about 3 times a week

It is done at home, about 3 times a week, usually started with a physiotherapist who visits a few times to set it up and make it harder as you improve. In trials with over 1,000 older adults, it reduced falls and fall injuries by about 35 percent. It worked especially well for people aged 80 and over.

Our follow-along Otago Strength and Otago Balance videos describe these exercises in our own words. Always do balance exercises next to something sturdy, like a kitchen counter.

Other ways to keep steady

• Stay active every day. Walking, dancing, gardening and swimming all help. The World Health Organization recommends that older adults do balance and strength activities on at least 3 days a week.
• Join a class. Many community centres offer falls prevention, strength and balance, or tai chi classes. Exercising with others is more fun and helps you stick with it.
• Use a walking aid if you need one. A physiotherapist can help you choose the right one and set the right height.

Something you can do this week: Stand at your kitchen counter, hold on with both hands, and practise rising up onto your toes 10 times. Do it every other day.

Questions to ask your care team

• Am I at higher risk of falling? Why?
• Can I have a falls risk check, or be referred to a falls prevention service?
• Can you refer me to a physiotherapist for the Otago programme or a strength and balance class?
• Could any of my health conditions be affecting my balance?
• Would a walking aid help me?
• How often should I do my exercises, and how do I make them harder safely?

This article is general information, not medical advice. Talk with your health care team about your own situation. In an emergency, call 9-1-1 or your local emergency number.

In an emergency, call 9-1-1 or your local emergency number.

General information, not medical advice. It does not replace your own care team. If you think you or someone else is having a medical emergency, call 9-1-1 or your local emergency number. If you are in crisis or thinking about suicide, call or text 9-8-8 (Canada and the US).

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